The TFOS International Workshop on Contact Lens Discomfort: Executive Summary

Nichols, Jason J.; Willcox, Mark; Bron, Anthony J.; Belmonte, Carlos; Ciolino, Joseph B.; Craig, Jennifer P.; Doğru, Murat; Foulks, Gary N.; Jones, Lyndon; Nelson, J. Daniel; Nichols, Kelly K.; Purslow, Christine; Schaumberg, Debra A.; Stapleton, Fiona; Sullivan, David A.

doi:10.1167/iovs.13-13212

Cited by 190 publications

(161 citation statements)

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“…41,42 This study proposes to provide additional evidence by (1) examining the relationships among tear osmolarity, TBUT (noninvasive and with fluorescein), and dryness symptoms measured using both subjective symptom rating scale questionnaires and a previously published categorical classification tool 43 and (2) determining whether these relationships differ with subject demographic characteristics or contact lens (CL) use. Our goal is to gain further understanding of the complex interrelationships among common clinical and subjective assessments used in the diagnosis and treatment of DE disease.…”

mentioning

confidence: 99%

Relationships among Tear Film Stability, Osmolarity, and Dryness Symptoms

Yeh¹,

Graham²,

Lin³

2015

Optometry and Vision Science

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Purpose To examine the relationships among tear osmolarity, tear film stability, and several measures of dry eye (DE) symptoms in a multivariable analysis. Methods A cross-sectional study was conducted with 137 subjects (68 non–contact lens [CL] wearers and 69 soft CL wearers) recruited from a university campus. Tear breakup time (TBUT) was measured noninvasively (NITBUT) and with fluorescein (FTBUT). Tear osmolarity was measured by an osmometer. Dry eye symptoms were assessed using the Dry Eye Flow Chart and several different questionnaires. Results Subjects ranged in age from 18 to 67 years, with a mean of 28 years. Subjects had a mean (SD) osmolarity of 293 (10) mOsm/L, NITBUT of 14.1 (10.9) seconds, and FTBUT of 14.8 (12.6) seconds. Shorter NITBUT and FTBUT were significantly associated with female sex (p = 0.001 and p = 0.027, respectively) and Asian ethnicity (p = 0.030 and p = 0.004, respectively). There were no clinically significant relationships between tear osmolarity and FTBUT, NITBUT, or DE symptoms. Higher Dry Eye Flow Chart score (i.e., worse symptoms) was associated with older age (p < 0.001), female sex (p = 0.014), CL wear (p < 0.001), shorter NITBUT (p < 0.001), and shorter FTBUT (p = 0.028). The sensitivities and specificities for using clinical measurements to diagnose moderate to severe DE were as follows: osmolarity, 0.67 and 0.46, respectively; NITBUT, 0.72 and 0.52, respectively; and FTBUT, 0.68 and 0.57, respectively. Conclusions In a population of asymptomatic, mild and moderate DE patients, increased tear osmolarity was not significantly associated with reported symptom severity and frequency. Tear osmolarity, NITBUT, and FTBUT exhibited similar sensitivities and specificities when used to diagnose moderate to severe DE.

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mentioning

confidence: 99%

Relationships among Tear Film Stability, Osmolarity, and Dryness Symptoms

Yeh¹,

Graham²,

Lin³

2015

Optometry and Vision Science

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“…1 As a condition characterized by episodic or persistent adverse ocular sensations related to contact lens wear, CLD occurs and results from reduced compatibility between the contact lens and the ocular environment. The resulting “discomfort” (which can vary in different individuals) stems from interactions among multiple psychophysical and neurobiological factors, which can lead to reduced lens wearing time or even termination of contact lens wear.…”

Section: Introductionmentioning

confidence: 99%

Lid Wiper Microvascular Responses as an Indicator of Contact Lens Discomfort

Deng

Wang

Jiang

et al. 2016

American Journal of Ophthalmology

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Purpose-To analyze quantitatively the alterations in the microvascular network of the upper tarsal conjunctiva, lid wiper, and bulbar conjunctiva relative to ocular discomfort after contact lens wear.Design-A prospective, cross-over clinical study.Methods-Functional slit-lamp biomicroscopy (FSLB) was used to image the microvascular network of the upper tarsal conjunctiva, lid wiper, and bulbar conjunctiva. The microvascular network was automatically segmented, and fractal analyses were performed to yield the fractal dimension (D box ) that represented vessel density. Sixteen healthy subjects (nine female and seven male) with an average age of 35.5 ± 6.7 years old (mean ± standard deviation) were recruited. The right eye was imaged at 9 AM and 3 PM at the first visit (Day 1) when the subject was not wearing contact lenses. During the second visit (Day 2), the right eye was fit with a contact lens for 6 h. Microvascular imaging was performed before (at 9 AM) and after lens wear (at 3 PM). Ocular comfort was rated using a 50-point visual analogue scale before and after 6 h of lens wear, and its relationships with microvascular parameters were analyzed.Results-There were no significant differences in D box among the upper tarsal conjunctiva, lid wiper, and bulbar conjunctiva among the measurements at 9 AM (Day 1 and Day 2) and 3 PM Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Financial Disclosures HHS Public AccessAuthor manuscript Am J Ophthalmol. Author manuscript; available in PMC 2017 October 01. Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript (Day 1) when the subjects were not wearing the lenses (P > 0.05), whereas after 6 h of lens wear, the microvascular network densities were increased in all three of these locations. D box of the lid wiper increased from 1.411 ± 0.116 to 1.548 ± 0.079 after 6 h of contact lens wear (P < 0.01). D box of the tarsal conjunctiva was 1.731 ± 0.026 at baseline and increased to 1.740 ± 0.030 (P < 0.05). D box of the bulbar conjunctiva increased from 1.587 ± 0.059 to 1.632 ± 0.060 (P < 0.001). The decrease in ocular discomfort was strongly related to the D box change in the lid wiper (r = 0.61, P < 0.05). There were no correlations between the changes of ocular comfort and the microvascular network densities of either the tarsal or bulbar conjunctivas (P > 0.05).Conclusion-This study is the first to show that the microvascular network of the lid wiper can be quantitatively analyzed in contact lens wearers. The microvascular responses of the lid wiper were significantly correlated with contact lens discomfo...

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“…Elucidating the mechanisms underlying CL discomfort is an issue that has eluded the field for decades. 8 The development of novel, functional CLs, such as drug-delivery devices 1,3,9 and biosensors, [10][11][12] is an area of growing interest, with substantial potential markets. In both circumstances, a sophisticated in vitro model would provide relevant information to assist with selecting appropriate lens materials or design characteristics during the development phase.…”

Section: Introductionmentioning

confidence: 99%

Development of an <em>In Vitro</em> Ocular Platform to Test Contact Lenses

Phan

Walther

Gao

et al. 2016

JoVE

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Currently, in vitro evaluations of contact lenses (CLs) for drug delivery are typically performed in large volume vials, 1-6 which fail to mimic physiological tear volumes. 7 The traditional model also lacks the natural tear flow component and the blinking reflex, both of which are defining factors of the ocular environment. The development of a novel model is described in this study, which consists of a unique 2-piece design, eyeball and eyelid piece, capable of mimicking physiological tear volume. The models are created from 3-D printed molds (Polytetrafluoroethylene or Teflon molds), which can be used to generate eye models from various polymers, such as polydimethylsiloxane (PDMS) and agar. Further modifications to the eye pieces, such as the integration of an explanted human or animal cornea or human corneal construct, will permit for more complex in vitro ocular studies. A commercial microfluidic syringe pump is integrated with the platform to emulate physiological tear secretion. Air exposure and mechanical wear are achieved using two mechanical actuators, of which one moves the eyelid piece laterally, and the other moves the eyeballeyepiece circularly. The model has been used to evaluate CLs for drug delivery and deposition of tear components on CLs. Video LinkThe video component of this article can be found at

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The TFOS International Workshop on Contact Lens Discomfort: Executive Summary

Cited by 190 publications

References 0 publications

Relationships among Tear Film Stability, Osmolarity, and Dryness Symptoms

Relationships among Tear Film Stability, Osmolarity, and Dryness Symptoms

Lid Wiper Microvascular Responses as an Indicator of Contact Lens Discomfort

Development of an <em>In Vitro</em> Ocular Platform to Test Contact Lenses

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